Expert Q & A with Dr. Nev Jones (Stanford University) in work with NASHMPD:

Jen Padron M.ED, ACPS, CPS, CHW, PhD(c)

Jen Padron is a nationally recognized expert on peer support and peer workforce development and is currently the Principal at Padron & Associates, based in Georgia. The consultancy are subject matter experts in co-locating Behavioral and Physical public health care environments which directly impact the US Peer Workforce (Certified Peer Specialist Certification). Before moving to Georgia, as Project Manager to The Hope Concept Wellness Center and Director to The HOPE Project her extensive experience as a recovery consultant and evaluation specialist supported Texas and national mental health transformative initiatives. Recently, Jen has contracted to provide technical assistance and program development on a Latino/a-focused early intervention in psychosis (EIP) peer support development project based in Southern Methodist University in Dallas.

Q: Given your expertise in peer support and peer workforce development, what do you think current priorities should. be for peer inclusion/support in EIP services?

Jen Padron: SAMHSA’s naming the Certified Peer Specialist as a Best Practice of Peer Services and Supports, paired with their recent CPS Core Competencies is fab. In order to be considered an EBP and melded into federal wordspeak, it “normalizes” a US Peer Workforce to grow and rolls-out proven Accountable Care Act public health Integration initiatives via various types of Peer Services | Supports deliverables. It also means that CLAS must be adhered to. In other words, the CPS must ultimately adhere to National Standards for Culturally Linguistically Appropriate Services (CLAS) in Health and Health Care. CLAS addresses and preserves multicultural, linguistic and diversity through inclusive accountability for ethnicity, religion, gender, age, geography and socioeconomic status, language and literacy, sexual identity where “orientation” and gender identity cross a binary continuum.

Q: Not a lot of work in early intervention has focused on cultural sensitivity or culturally-informed intervention. Why do you think such work needs to be prioritized?

Jen Padron: Priority #1. In simple terms, the backstory on Recovery, is still that she is the orphan child of the clinically medical based psychiatric and psychological community globally. More than the majority of early interventions center around people identified as living with a schizophrenia affective disorder. There are numerous longitudinal studies having ease in quantifying where something as “new” as the CPS does not. If you want Recovery-based look at time tested work coming out of Boston University, University Pennsylvania, Temple University, Rutgers University, Yale University, the University of Southern California, the University of Missouri-St. Louis, the work of Pat Deegan, Mary Ellen Copeland, Steve Harrington, Sheri Mead and Chris Hansen, Dan Fisher, Peggy Swarbrick, Mark Salzer, John Brekke, Laysha Ostrow, Lauren Tenney, Ron Manderscheid and others. It is interesting to me but makes total sense that most, if not all of innovative and emerging work around Recovery, the CPS, Recovery Coach, Community Health Worker Promotora is being developed by peer-led interest groups who are carefully tucked into national oversight behavioral and health leadership organizations (e.g., ACMHA College for Behavioral Health Leadership’s Peer Leadership Interest Group) and initiated MCO Integration initiatives are rolling out (in ’15-’16) an array of CPS service deliverables that will grow a US Peer workforce exceeding the recognized state’s Medicaid Rehabilitation Option billing model (e.g., Psychosocial Rehabilitation, Medications Management, Case Management). As well, the national consumer related TACs, funded by SAMHSA are doing excellent work (e.g., BRSS TACS, Peer Link, MHA National, The National Self-Help Consumer Clearinghouse/MHASP).

Q: How do you see peers in particular contributing to culturally-informed services, including planning and evaluation?

Individuals with shared life experience of mental diversity play a vital role (e.g., Certified Peer Specialist) of providing peer services and supports in the mental health and behavioral health care settings (SAMHSA, 2013). The Certified Peer Specialist is effective in promoting behavioral change in service recipients they serve by increasing utilization rates and providing significant reductions in hospital admissions and re-admissions (Fedder, Chang, Curry, 2003).

The Certified Peer Specialist (CPS) provides for behavioral and physical wellness health coaching supports in an integrated setting (Swarbrick, M. (2013); Manderscheid, R (2013). The CPS is the vehicle that the US Peer workforce will initially exemplify the multitude of roles and is the only available source provider for peer services and supports where service deliverables are sustainably funded by the Medicaid and Manage Care Organization (MCO) peer supports in the ACA market. This is a public/private health care sustainable funding model. Peer Services | Supports are a win/win wellness and whole health solution in today’s ACA environment utilizing peer-driven services (Vestal, C. 2013) to co-locate in behavioral and physical integrated care environments.

Mitigating rising health care costs and a fundamental shift in reimbursement is occurring. “Patients” and organizations, alike, are inherently required to transition from an episodic, fee-for-service model of reimbursement to a new model that reimburses and encourages money in the pocket wellness and care across the health service continuum.

A wellness focus on prevention and coached self-activated management of chronic conditions that our population experiences with early intervention and prevention, care experience will improve, providers will be better able to deliver quality care seeing an overall reduction in costs.

Workforce Trends

The professional workforce in the future will be smaller, and the work itself will be different than it is today. Projections for nursing shortages and primary care physician shortages have been published widely, and the shortage of primary care physicians will only be exacerbated by increased demand for their services by 2014. This is due to the aging population, the addition of an estimated 32 million patients into the system as a result of ACA, and the increasing movement of chronic disease care into the ambulatory arena.

To function as seamless efficient teams, all health care professionals (both current and future) must be trained in inter-professional educational and cross-trained settings. This represents a major challenge for our centers of professional education to innovate in the redesign of both pre-clinical and clinical curricula.

The US Certified Peer Specialist (CPS) certification currently operates and is managed by an irregular un-uniform state by state “Recovery Waiver” Medicaid reimbursement mechanism limited to local mental health authorities clinical supervising teams offering psychosocial rehabilitation, medication compliance monitoring and various kinds of community resource linkage.

As of April 2014, 39 states and the District of Columbia have established programs to train and certify peer specialists and 7 states are in the process of developing and/or implementing a program. Appalachia Consulting (Fricks & Powell, 2015) contracted proprietary CPS curricula is used in 23 states. Recovery Resources (Harrington, 2015) free CPS curricula is broadly used by the Department of Veterans Affairs and a limited number of states. Recovery Innovations/Recovery Opportunities (Ashcraft, 2015) contracted and proprietary CPS curricula is also broadly used. Fewer states utilize an in-state developed CPS curricula. There is minimal CPS certification reciprocity between particular states requiring application and testing to acquire state certification.

This unique rural alcohol and drug abuse conference provides participants the opportunity to personally interact with other rural alcohol and drug abuse professionals, federal agency representatives and nationally known institute faculty and resource individuals while accessing the latest in evidence-based practices for the improvement of rural services.

It has been said, “The social power to define and categorize another person’s experience is not a power to be ignored.” The health activation movement is alive and well at the 2015 College for Behavioral Health Leadership Conference. Last week, I had the privilege of presenting about health activation with Adam Slosberg, peer specialist and managing director, Beyond Today International. Declaring 2014 the year of the peer health activation has taken center stage for peer training and professional enhancement, in behavioral health and in the criminal justice system.

According to The National Council for Behavioral Health, Whole Health Action Management (WHAM) training is a peer-led intervention to activate whole health self-management in community mental health centers, federally qualified health homes and Veteran Administration programs. Designed by The Substance Abuse and Mental Health Services Administration (SAMHSA) and Center for Integrated Health Solutions, this initiative will assist and intervene with those persons working to activate their health and recovery from mental illness and co-occurring addictive and other medical disorders.

For the full article, “The Need for Health Activism in the Criminal Justice System” published today by the Huffington Post, go to: